C0503 - Longer Time to Recovery From Acute Kidney Injury Is Associated with Increased Major Adverse Kidney Events in Patients With Cirrhosis

Monday, October 24, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Astin Worden, MD

Indiana University School of Medicine
Indianapolis, IN

Astin Worden, MD¹, Mobasshir Naved, MS², Shoawli Kabir, PhD³, Ananth Grama, PhD², Mohammad Adibuzzaman, PhD⁴, Archita Desai, MD¹, Marwan Ghabril, MD¹, Lauren Nephew, MD, MSCE¹, Naga Chalasani, MD, FACG¹, Eric Orman, MD¹, Kavish Patidar, DO¹
¹Indiana University School of Medicine, Indianapolis, IN; ²Purdue University, West Lafayette, IN; ³College of Public Health, University of Kentucky, Lexington, KY; ⁴Oregon Health Sciences University, Portland, OR

Introduction: In patients with cirrhosis, non-recovery from acute kidney injury (AKI) is associated with major adverse kidney events (MAKE). However, in patients with AKI recovery, little is known about how the timing of recovery affects the risk of MAKE. Thus, we aimed to examine the association between timing of recovery and risk of MAKE in patients with AKI recovery.

Methods: Hospitalized patients with cirrhosis and AKI in the Cerner Health Facts database from 1/2009-09/2017 were assessed for AKI recovery and were followed for 180 days for outcomes. The timing of AKI recovery [return of serum creatinine (sCr) < 0.3mg/dL of baseline] from AKI onset was grouped into 0-2, 3-7, 8-14, and >14 days. The primary outcome was MAKE at 90-180 days. Per consensus definition, MAKE was defined as the composite outcome of >25% decline in estimated glomerular filtration rate (eGFR) compared with baseline with CKD stage >3 or progression of CKD (defined as >50% reduction in eGFR compared with baseline) or new hemodialysis. Competing risk multivariable modeling (death/transplant as competing risk) was performed to determine the independent association between timing of recovery and risk of MAKE.

Results: Out of 6,250 eligible patients, 4,655 (75%) achieved AKI recovery. The median age was 60 years [interquartile range (IQR) 25, 70], 71% White and 60% male. The most common etiologies of cirrhosis were non-alcoholic steatohepatitis (38%), alcohol (27%), and hepatitis C (17%), and the median (IQR) MELD-Na score was 23 (16, 28). 60% had ascites and the median baseline sCr was 1.00 (0.70, 1.44) mg/dL.

The characteristics of patients who recovered 0-2 (n=2,791, 60%), 3-7 (n=1,455, 31%), , 8-14 (n=255, 5%), and >14 days (n=184, 4%) after AKI are shown in Table 1. The incidence of MAKE was 12%, 16%, 22%, and 25% for 0-2, 3-7, 8-14, and >14 days recovery groups, respectively. On adjusted multivariable competing risk analysis, compared to 0-2 days, recovery at 3-7, 8-14, and >14 days was independently associated with an increased risk for MAKE: sHR 1.48 (95% CI 1.03-2.14, p=0.036), sHR 2.92 (95% CI 1.11-4.31, p=0.023), and sHR 2.60 (95% CI 1.37-4.96, p=0.004), respectively.

Discussion: In patients with cirrhosis who recover from AKI, longer time to recovery is associated with an increased risk of major adverse kidney events. Interventions to hasten recovery from AKI should be considered in patients with cirrhosis who develop AKI.

Variable	0-2 Days N=2,791	3-8 Days N=1,455	8-14 days N=225	>14 days N=184	P-value
Age	60 (52, 69)	62 (53, 71)	62 (55, 71)	60 (50, 68)	< 0.001
Race, white	71	71	68	68	0.069
Sex, male	61	59	60	59	0.925
Etiology of cirrhosis Hepatitis C Alcohol NASH Other Unknown etiology	17 29 37 5 12	18 24 40 6 12	17 19 47 6 11	21 27 34 6 12	0.635 0.001 0.006 0.518 0.966
Ascites	56	66	68	73	< 0.001
Hepatic encephalopathy	25	27	31	32	0.054
Diabetes	50	55	64	54	< 0.001
Hypertension	57	60	63	9	0.044
Baseline creatinine, mg/dL	0.94 (0.70, 1.44)	1.00 (0.74, 1.42)	1.10 (0.80, 1.74)	1.07 (0.76, 1.82)	< 0.001
MELD-Na at time of AKI	20 (14, 26)	24 (19, 29)	26 (21, 30)	26 (23, 31)	< 0.001
Stage of AKI at diagnosis 1/2/3	87/10/3	69/20/11	61/21/18	63/14/13	< 0.001
Peak AKI stage 1/2/3	75/13/12	48/27/25	20/31/49	16/21/63	< 0.001
Infection	25	30	41	35	< 0.001
Required ICU care	24	28	37	33	< 0.001
Mechanical ventilation use	12	14	24	12	< 0.001
Vasopressor use	14	17	24	23	< 0.001

Table: Table 1: Comparison of Patient and Clinical Demographics Between AKI Recovery Groups.
Continuous variables shown as median interquartile range (IQR); categorical variables presented as %

Disclosures:

Astin Worden indicated no relevant financial relationships.

Mobasshir Naved indicated no relevant financial relationships.

Shoawli Kabir indicated no relevant financial relationships.

Ananth Grama indicated no relevant financial relationships.

Mohammad Adibuzzaman indicated no relevant financial relationships.

Archita Desai indicated no relevant financial relationships.

Marwan Ghabril indicated no relevant financial relationships.

Lauren Nephew: Delfi – Grant/Research Support.

Naga Chalasani indicated no relevant financial relationships.

Eric Orman: Biovie Inc. – Advisory Committee/Board Member.

Kavish Patidar indicated no relevant financial relationships.

Astin Worden, MD¹, Mobasshir Naved, MS², Shoawli Kabir, PhD³, Ananth Grama, PhD², Mohammad Adibuzzaman, PhD⁴, Archita Desai, MD¹, Marwan Ghabril, MD¹, Lauren Nephew, MD, MSCE¹, Naga Chalasani, MD, FACG¹, Eric Orman, MD¹, Kavish Patidar, DO¹. C0503 - Longer Time to Recovery From Acute Kidney Injury Is Associated with Increased Major Adverse Kidney Events in Patients With Cirrhosis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.